Provider Demographics
NPI:1962654426
Name:A WAKEFIELD WALK-IN & PRIMARY CARE LLC
Entity Type:Organization
Organization Name:A WAKEFIELD WALK-IN & PRIMARY CARE LLC
Other - Org Name:BALD HILL WALK-IN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:B
Authorized Official - Last Name:EDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN ASSISTANT
Authorized Official - Phone:401-284-1515
Mailing Address - Street 1:553 KINGSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3600
Mailing Address - Country:US
Mailing Address - Phone:401-932-5526
Mailing Address - Fax:401-789-1327
Practice Address - Street 1:553 KINGSTOWN RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3600
Practice Address - Country:US
Practice Address - Phone:401-932-5526
Practice Address - Fax:401-789-1327
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A WAKEFILD WALK-IN & PRIMARY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-15
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care